What’s Love Got to Do with It? Embracing Physiological Birth

Physiological Birth - Hatch Midwifery

The Essence of Physiological Birth

It is no secret that I’m a huge proponent of building teams of support around laboring parents with the goal of an unmedicated vaginal birth. Before I draw the ire of everyone who has had and loved their epidural – hang on – I also believe that there are very real reasons to use an epidural in labor. Sometimes an epidural is the most compassionate thing we can use to help support a laboring person. Sometimes it helps to achieve the goal of a vaginal birth. But for reasons that we’ll discuss here, epidurals and other interventions can sometimes get us further from our goals or leave us feeling disappointed if we’ve felt that they were pushed on us.

 Before we get too far ahead of ourselves, this is not a post about epidurals. Rather, this is a love letter to physiological birth – in other words, birth as the human body was designed to experience it. Check out this animated short that is so beautifully able to convey the power of physiological birth without any words at all.

Understanding the Physiology of Birth

I’m going to spend a little time geeking out on the science of childbirth as we currently understand it. BUT I will also start all of this with a huge asterisk and say that, despite all the research articles that have been written on hormone cascades and fetal development, we still do not completely understand the hidden magic of what makes labor begin. I am totally in awe of the fact that this most fundamental phase of human existence continues to evade our complete understanding and instead remains stubbornly shrouded in mystery. Sometimes, my drive to understand has me scouring research articles to see if we’ve cracked the puzzle. But most days, I am content with believing that the ‘not-knowing’ is an invitation to accept and believe that underneath it all, it really is just a tiny miracle.

We could just stop there, but I wanted to talk about the physiology of birth so that you might better understand why so many midwives seek to promote it. So, what do I mean by physiological birth? I mean a birth that is achieved with the pregnant parent’s own bodily efforts and strength without the aid of medical interventions.

While our understanding of physiological birth remains incomplete, what we do know is that the uterus is a contractile organ. Its day job is to contract – to expel menstrual blood every month (give or take) and to birth our babies. However, in order to sustain a pregnancy for 9 months (again, give or take), the uterus has a side hustle, which is to stop contracting and stay relatively relaxed. It does this with the help of a bunch of hormones and compounds our bodies make during pregnancy (such as progesterone, relaxin, and others).

The maintenance of those hormones and compounds throughout pregnancy keeps us pregnant. As we get closer and closer to our baby’s birthday (whenever that may be), our body begins to slowly reduce progesterone activity. This change allows for a series of changes that allows the uterine muscle to resume its normal job of contracting. One of the main changes is the expression of oxytocin receptors in the uterine muscle.

Oxytocin: The Key to Natural Labor

Let’s pause here for a second. Have you heard of oxytocin? Many of us have learned about it as the ‘love hormone.’ We have surges in oxytocin when we fall in love or when we feel sexually excited; it helps us feel relaxed and trusting and contributes to our psychological stability. Around childbirth, oxytocin released by our brains sends messages to our uterine muscle to contract and birth our babies; its release also contracts the smooth muscle in the mammary tissue to release milk for your baby (more on that later). So, all in all, oxytocin is pretty cool.

Alright, back to getting ready for labor. So, now we have less progesterone and our uterine muscle is expressing more and more oxytocin receptors. It’s not that we don’t have a lot of circulating oxytocin in pregnancy; it’s just that towards the end of pregnancy, with all those oxytocin receptors, we’re now more sensitive to oxytocin-causing contractions. This is why we may experience more toning or practice contractions towards the end of pregnancy. Along with the changes in our bodies, our babies are experiencing their own shifts near the end of pregnancy. One of the bigger shifts is a dramatic increase in the baby’s cortisol production.

Navigating Cortisol: A Balancing Act in Birth

Hold on, wait a minute, isn’t cortisol the stress hormone? Aren’t we supposed to be minimizing stress to achieve physiological birth?? Why is a sudden increase in the baby’s cortisol getting us closer to childbirth?? Well, cortisol is like your relationship with your in-laws; it’s complicated. (Just kidding, I’m sure your in-laws are delightful, just like mine). On the one hand, your baby’s ability to make cortisol helps their lungs and other vital organs mature in the final days and weeks of pregnancy. On the other hand, high levels of cortisol in the pregnant person due to life stressors can cause babies to be small and arrive too early. Well, it turns out hormones are like so many other things in our lives -they are better in moderation. To complicate matters further, the baby’s cortisol-producing system acts differently than that of the pregnant person. The baby’s cortisol acts in a feed-forward loop, which increases cortisol and related hormone levels, whereas the pregnant person’s cortisol acts in a negative feedback loop, which causes reductions in more cortisol and related hormones. You can read this as: the baby’s body understands its own cortisol to be useful in preparing their body for birth, whereas the pregnant person’s body understands their own cortisol as a sign of stress and seeks ways to reduce it. This all makes sense when you begin to see the pregnant person and the baby as the two individuals that they are. While there is some admixing of hormones and compounds between the pregnant person and the baby, it is not complete sharing and the two systems can generally coexist.

Environmental Influence on Labor Progression

Now, back to our pregnant body and our developing baby. We know that it is something about the baby’s cortisol production and the downstream effects that ultimately lead to labor and childbirth but this is the magical mystery part: we don’t know what the last combination of steps is. What we do know is that our environment and our support system can do a lot to either support the hormones of labor or detract from them.

You may be thinking, why is labor so sensitive to our environment and support? To understand that, we need to remember that WE ARE ANIMALS – animals that used to live in the wild with predators that could harm our young. Imagine a pregnant deer. Her labor has just started. She makes her way to a warm, sunny glen with a small pond and patches of soft grass – a perfect place to birth her fawn. This perfect environment makes her feel supported and safe and the oxytocin surges in her body, bringing on labor. Now imagine that she hears a twig snap, and she picks up the scent of a wolf nearby. Suddenly her body is coursing with stress hormones, which help her labor to shut down or stall so that she can run away and find a safer place to birth her fawn.

Our stress response systems, which developed millions of years before dwellings and modern medicine, were created as a response to physical danger and not for some of the modern psychological stressors we can experience today. The hormone-producing organs cannot tell the difference between the fear that you feel towards strangers in masks under bright lights touching your body and a wolf. All that those sensing organs know is ‘you feel scared, I can help you get away.’

Personalized Support for Your Unique Birth Journey

That being said, the best way to support physiological birth is to support those primitive hormone systems – we need to support the flow of oxytocin (the warm, sunny glen) and reduce exposure to the stressors (the wolf).

Cultivating a Supportive Birth Environment

Now, this is where things get personal. Everybody’s wolf is different.  Everybody’s warm, sunny glen is unique. One birthing person may feel completely secure and safe birthing in the comfort of their own home, whereas another person may feel very nervous about birthing outside of a hospital. One person may embrace and enjoy the support of family and loved ones during labor, while another may want to be alone in a bathroom in the dark. One person may welcome the sensations of labor as a primal and rewarding experience of personal strength, while another may feel anxious and increasingly afraid with each passing contraction. Hatch Midwifery exists to honor those differences.

Your Birth Preferences Matter: Honoring Individual Choices

There are no right or wrong preferences. It is our individual selves that show up for the moment of birth. All that we are made of – our tolerance for risk, our faith and cultural practices, our partnerships – are the very things that tell us what feels safe and what does not. My favorite part of prenatal care is getting to know you and your preferences, while exploring the things about your birth journey that have you feeling excited or nervous. We work to explore any fears you may have around childbirth to create birth preferences that feel comforting to you and that help you cultivate a birthing environment that will maximize the flow of oxytocin.

Partnering with Hatch Midwifery for a Nurturing Birth Experience

If this makes you feel excited, please reach out and let’s chat about ways that I can support you and your team as you prepare to welcome your sweet baby earthside.

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